AB0261 CARDIOMETABOLIC COMORBIDITIES MAY IDENTIFY A MORE SEVERE SUBSET OF RHEUMATOID ARTHRITIS, RESULTS FROM A “REAL-LIFE” STUDY
Authors: P. Ruscitti, A. Conforti, C. DI Muzio, D. Currado, L. Navarini, V. Pavlych, I. DI Cola, F. Sensini, A. Biaggi, S. DI Donato, A. Marino, S. Lorusso, F. Ursini, R. Giacomelli, P. Cipriani
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease associated with a significant increased rate of cardiometabolic comorbidities contributing to an increased risk of morbidity and mortality of these patients [1,2]. RA patients with cardiometabolic comorbidities might differ from those without in their clinical presentation and prognosis. Objectives This “real-life” cross-sectional study was designed to describe disease features of RA consecutive participants affected by cardiometabolic comorbidities than those without, among those attending recruiting centres from January 1, 2021 to December 31, 2021. Our purpose was also the identification of possible associations between these diseases and clinical characteristics of patients (i.e. fulfilment of ACR1987 criteria, ACPA positivity, presence of extra-articular manifestations, remission, and bDMARD failure). Methods Consecutive RA patients were assessed, all fulfilling 2010 ACR/EULAR criteria for RA. We have defined the participant as having such comorbidities if affected by 2 or 3 among high blood pressure (HBP), type 2 diabetes (T2D), and/or dyslipidaemia. The presence of cardiometabolic comorbidities for each participant was verified by reviewing the clinical charts, interview, and extensive medical examinations. Patients with and without cardiometabolic comorbidities were grouped and compared. After that, regression models were built to assess the influence of the presence of cardiometabolic comorbidities on RA features of disease severity. Results 757 consecutive RA participants were evaluated [(female 56.6%, age 64.7 ± 12.3 years, median disease duration 6 years (IQR 12)]. Among assessed participants, 13.5% showed cardiometabolic comorbidities. These were older (63.9 ± 13.1 vs 70.4 ± 9.0 years, p&lt;0.001) and characterised by a longer disease duration with 64.7% between 5 and 10 years (p=0.003). They were more often affected by extra-articular manifestations (8.2% vs 17.7%, p=0.029) and frequently displayed smoking habit (36.6% vs 50.0%, p=0.003). A lower percentage of participants with these comorbidities was in remission (15.7% vs 8.5%, p=0.048) and they showed a higher prevalence of history of bDMARD failure (40.4% vs 78.4%, p&lt;0.001). Finally, regression models showed that cardiometabolic comorbidities were significantly correlated with RA features of disease severity. Participants with cardiometabolic comorbidities more frequently fulfilled ACR1987 criteria in both univariate (OR: 1.47, 95%CI: 1.15-1.89, p=0.002) and multivariate analyses (OR: 1.48, 95%CI: 1.15-1.91, p=0.002). These participants had a higher probability of ACPA positivity in both univariate (OR: 1.52, 95%CI: 1.10-2.09, p=0.009) and multivariate analyses (OR: 1.47, 95%CI: 1.06-2.04, p=0.020). Cardiometabolic comorbidities also predicted the presence of extra-articular manifestations in both univariate (OR: 3.26, 95%CI: 1.77-5.89, p&lt;0.001) and multivariate analyses (OR: 2.41, 95%CI: 1.30-4.87, p=0.005). Participants with cardiometabolic comorbidities had a higher probability of previous bDMARD failure in both univariate (OR: 1.73, 95%CI: 1.24-2.43, p&lt;0.001) and multivariate analyses (OR: 7.17, 95%CI: 3.61-14.2, p&lt;0.001). Cardiometabolic comorbidities resulted to be a negative predictor of being in remission in both univariate (OR: 0.53, 95%CI: 0.39-0.97, p=0.041) and multivariate analyses (OR: 0.61, 95%CI: 0.41-0.96, p=0.035). Conclusion We described disease features of RA participants with cardiometabolic comorbidities, identifying a disease subset characterised by clinical features of disease severity and to be considered as “difficult-to-treat”. Thus, cardiometabolic comorbidities may represent a considerable burden for RA patients requiring an appropriate management which should focus, in addition to cardiovascular risk prediction, on targeting these metabolic components. References [1]England BR, et al. BMJ. 2018;361:k1036. [2]Ferguson LD, et al. Nat Rev Rheumatol. 2019;15:461-474. Disclosure of Interests None declared